Video Games as Therapy
We previously defined therapy as a course of action that facilitates introspection and self-understanding for the actors in question by allowing them to engage in methods of coping, distraction, and so on. With that understanding, the act of playing video games—if it provides these experiences for a player—could be seen as therapeutic, and in fact, their application as such has been explored by many different fields of study.
The concept of video games being able to provide emotional comfort and physical rehabilitation isn't exactly new, and actually connects to the concept of video games as art quite directly: one of the main aspects of therapy is the ability to facilitate communication, either between multiple people or within one's self1, and as we established in exploring video games as art, the creation and consumption of art allows for communication between the artist and the viewer, as well as communication between the art itself and the viewer. There's a presumption that exists with art that depends upon its location and its presentation, and that presumption exists with video games as well: think of box art, or even a title screen, as a video game's "museum": it's the way the piece is mounted on the wall, the placard next to the piece with the artist and title. Even if there isn't direct communication with developer and player, implicit communication will always exist, as we'll see in a later section.
It's difficult to talk about the effectiveness of video games as therapy mostly because the nature of therapy is so dependent on the individual. Making a blanket statement would not only oversimplify the subject, but do a disservice to those who have used video games therapeutically, since their effects vary based on the individual's background, experiences, and so on. However, from the various studies that have been conducted and theories that have been developed on the use of video games therapeutically, we can identify four aspects that help necessitate the self-understanding and coping mechanisms of therapy: communication, projection, empathy, and physical effects.
"Communication" is a pretty broad concept, but here we are talking about both the conveyance of a concept from one party to another. There is a unique experience that all forms of art bring to the table, because there is always disconnect between the artist and their creation, and the creation and a viewer: in many ways, the artwork often stands in place of an artist, even if that is not the intent, and there is often loss of original meaning by the creator, although whether that loss is significant is another conversation entirely. Here, we see both communication between a player and a narrative presented through a video game as therapeutic, and the communication between multiple players as therapeutic: both equally important to the theory.
The former—communication between a player and a narrative—is something that connects quite intrinsically to video games as art, as well as to the elements of projection and empathy, which we'll cover later. In broader terms, the format and involvement of a video game and the way it presents a narrative and immerses the player in a world and its characters can allow for players to project themselves and their background into the narrative of the game, and through such a process, cope and recognize their own strengths and solutions: either through being able to actually craft and create their own narrative, or by identifying with the characters and situations presented. Throughout this topic, it's important to keep in mind that this aspect of communication and interaction is one that is at the root of both video games as art and as therapy.
Communication between a player and a game is one thing, but what is most unique about the medium of video games is their ability to be a connection for groups of people across all generations.
Allow me to delve into some personal narrative here: throughout most of my life, video games have played some prominent roles in my interactions with friends and family. I have early memories of sitting on the couch, watching my brother play Sonic the Hedgehog on our brick of a Sega Genesis, or chilling on the porch of a friend's house after a long summer day of goofing off as we battled Pokémon, the bulky link cable connecting our Game Boy Colors stretched across the concrete slab.
Some people might view this concept of video games being so connected in my life on the surface as vapid, that we spent more time huddled over tiny screens than playing in the so-called "real world." But video games were a commonality for us, where we could all enjoy something outside of the stresses of school and obligations. Now that we're all spread across the country, living out our own lives and careers, that commonality still brings us together, and at times, makes us forget the thousands of miles that separate us from one another. We can joke around, laugh, and have fun without worrying about the "real world" that we've now been forced into as adults.
This enjoyment, even over something that some might not consider a meaningful connection, is so important to the process of healing and coping with stress and fears for me: for my generation, video games have become a fluent language of communication for us, and thusly, being able to escape into them for solace or communicate with others through them is as natural as picking up the phone and calling and old friend who now lives across the country. But I want to stress that this isn't just a singular event: studies show that people who play video games together often have deeper relationships with their peers, and overall live happier and fuller lives.
Jane McGonigal explores this in-depth in her TED Talk, "The Game That Can Give You 10 Extra Years of Life". Through it, she presents the concept that playing video games can help people live fuller, happier lives, going on to cite that those who participated in online games for about thirty hours a week showed decreased symptoms of depression and anxiety versus those who did not. She continues this idea with a personal anecdote: how she was bed-ridden for three months due to a concussion, and fell into a deep depression, which was uplifted by applying game mechanics—much like the logic of problem solving—to her recovery through collaboration of her loved ones. She later published her game concept online for others to use in their own lives and heard similar positive responses from others who implemented the game.
She later presents the idea of post-traumatic growth, and how the problem solving mechanics of a game system help to promote this growth. She goes beyond just the concept, however; she implements scientific research to propose that this growth can be achieved without trauma through "quests" that promote four traits: physical resilience, willpower resilience, emotional resilience, and social resilience.
The ability for video games to facilitate active communication, teamwork, and bonding with other people is integral to them being considered therapeutic, because even though it might not be seen as such on the surface, that interaction is a form of creation. When you play a game with someone, you're creating a shared experience, a relationship of collaboration. It is something that goes beyond just a common interest, more than a connection of "hey, you like the same thing as I do!" Because video games are such an aesthetic experience—so immersive that there is no divide between the you playing the game and the "you" within the game, the "you" as a protagonist—that shared experience of playing a video game becomes a strong bond: you have both committed yourselves to a story and a world, and each other as competitors or teammates, and you have come through the experience together.
For me, therapy is as much about understanding yourself as it is about understanding that you're not alone in your struggles, and the shared experience of playing a video game with someone or a group of friends makes that statement loud and clear.
Moreover, the concept of communication via video games is one almost intrinsically linked to player projection, but whereas the former topic focused on how video games can facilitate communication between people, the latter is more concerned with how a player can communicate and express themselves through the tools and structure (or lack thereof) that a video game provides.
There are two main examples of this element: the first arising from games that are not particularly plot-driven. There is no overarching narrative, no predetermined characters: players are responsible for creating the world around them within the game, and are responsible for creating the characters within that world. These "simulation" and "sandbox" type games allows for players to thusly express their own narrative through the tools of the video game, versus just experiencing a narrative and characters that the video game presents.
This is seen most often in games like Minecraft or The Sims, the former especially which has become a tool for creators to make their own packaged "adventures" within the environment of Minecraft itself. Simply, through these types of games that lay a groundwork for your own exploration, players become the creative and narrative force within them, since there is not one provided. Players are able to project their own aspirations and emotions onto the characters they create, as they are blank slates to do with what you will. Instead of connecting with a provided narrative, the aspect of therapy comes from the same way that art is therapeutic: it is the action of creation that provides relief and understanding, much like how art functions as therapy.
Even the simple concept of the silent protagonist can allow for projection from a player, both as way to understand themselves and as a coping mechanism, an escape. The same way that games like Portal are considered art because of the way they reinterpreted the medium and call many of the associated tropes into question: through the use of an unestablished, non-speaking protagonist and a first-person perspective, the relationship of the game mechanics and the narrative quality create an "emotional resonance" between the in-game protagonist and the player. The player's victories become the protagonist's victories, the suffocation that the protagonist experiences becomes suffocation that the player experiences, and so on. Solving a puzzle not only progresses you further in the game, but you experience actual pride and elation from figuring the puzzle out2. In a different example, Portal perverts the traditional relationship between player and protagonist, subverts several well-established tropes, and discusses what it means as a player to escape into and from a game, when the characters within that world cannot escape themselves. The trust the player has in the narrator is questioned (and eventually out right disestablished), and the only way to succeed in the game is to perform tasks that the "game" basically doesn't want to happen.
But much like readers can escape into the setting and characters of a novel, relate to the protagonists or antagonists and see themselves in a different world, such can be done with video games, but on an much more active level of involvement within the world of the game: because of the crafting of an entire world that often exists within video games, there is a merge between the "self" playing the game and the "self" in the game and these brief escapes from real world stressors become important coping techniques for many people.
It's important to note that this idea is not just a fleeting one: it has been applied to various fields to couple with clinical therapy3: for example, the application of video games as way to allow sufferers of war-related post-traumatic stress disorders to take control of their nightmares and thusly suffer from less of them as a result.
A researcher at Grant MacEwan University in Edmonton, Jayne Gackenbach, has studied this phenomenon closely. She states that those who play video games are able to gain control in stressful situations, like nightmares, thus leading to lucid dreaming, allowing the dreamer to consciously act in their nightmares, versus being victims of them. Even if Gackenbach's theory isn't particularly perfect, being a limited study only applied over a small range of patients, others—specifically Dr. Greg Passey, a post-traumatic stress disorder expert—states that video games can help suffers of PTSD because it helps them to zone out and ignore the anxiety and stressful thoughts. Passey does state, however, that games with elements that simulate extremely violent combat similar to experiences in war can make the PTSD worse.
With how communication and projection have been defined so far, bringing in something like "empathy" might seem like a redundancy, but when I say empathy, I'm not talking about multiple players creating connections and empathizing with each other (as talked about in communication), or the ability for a player to see themselves and escape into another world (as covered in projection). What I'm really trying to get at is communication between the creator of a video game and the player.
As video games have become a much more accessible medium, more people have been using it as a form of expression, meaning that voices that normally would not be heard among a strict industry setting4 are able to find a platform and an audience to voice their own struggles and feelings. Such games often fall out of the traditional definition of what a video game "is"5, but that doesn't make them any less important in the idea of communication and empathy. Through these often "experimental" games, a creator can communicate to a wide range of audiences about the. Games such as Zoe Quinn's Depression Quest are paramount in this aspect, allowing for those who suffer through similar experiences to feel represented and understood, and allowing for education to spread to those unfamiliar with such issues. Video games have so much power as an accessible medium to increase understanding and compassion among people: the core of empathy.
As a wrap-up, there are (generally) three concepts that make up the idea of video games functioning as therapy: communication (between both the game and a player, and video games being able to facilitate communication and connections between multiple players), projection (the ability for a player to immerse and see themselves within the game environment), and empathy (the ability for a creator to communicate to a player through the medium of the game).
If you've gotten a sense of deja-vu throughout this section, that's sort of intentional: a lot of this stuff should seem to echo concepts mentioned when we talk about video games functioning as art, because a lot of the concepts are connected, which is what brought this research together in the first place. And even further, when we talk about art functioning as therapy, it's probably going to seem even more like an overlap, but that's what we're working toward: a big messy overlapping Venn diagram that resulted in a little video game about a bunny or whatever.
Maybe you should just continue to the next section by now, yeah?
Back to VIDEO GAMES AS ART Continue to ART AS THERAPY1: The concept of introspection and self-discovery and understanding being treated as a self-communication, in this case. (Back to text) 2: If the game is well-designed, that is. If it's not, well, that's another thing entirely. (Back to text) 3: It's also important to note that video games have been applied in physical therapy as well, and even though that is not really directly applicable to my own focus (being emotional therapy and understanding), in many cases of physical injury or illness, one cannot exist without the other. The application of video games to facilitate physical therapy spans across many physical trauma and illness, including cerebral palsy and other traumatic brain injuries (especially in the use of "virtual reality" games that require active movement, such as games that use Nintendo Wii motion controls or the Microsoft Kinect motion tracking controls). (Back to text) 4: While many may still view video games as a niche market, it's hard to deny that only certain voices (in most cases, the straight, white, affluent male voice) are expressed within it, and other voices shunned. (Back to text) 5: Again, a conflict between a mainstream definition versus a much more accepting and loose one (much like the issue between fine art and "art", generally). (Back to text)